Hepatitis B screening disparities in the United States: An implementation-focused narrative review

To examine Hepatitis B Virus (HBV) epidemiology in the United States through an implementation and equity lens, with a focus on how inadequate screening and vaccination practices contribute to persistent disparities, and to synthesize evidence on interventions that improve screening uptake.

Narrative review with implementation focus.

A thematic analysis was conducted across 24 peer-reviewed studies examining HBV epidemiology, screening practices, disparities, and intervention strategies in the United States. Studies were synthesized to identify recurring patterns in disease burden, structural barriers to screening, and evidence-informed approaches to improve screening and linkage to care.

Foreign-born individuals were a significantly marginalized group, comprising 69% of chronic HBV infections in the United States while only making up 14% of the population. Yet, screening rates remain low among immigrants, particularly the Asian population with only 30-50% of the infected having been screened. Additional high-risk populations include people who inject drugs, men who have sex with men, individuals with multiple sexual partners, sex workers, and infants born to HBV-positive mothers. Evidence indicates that culturally and linguistically tailored digital tools, targeted provider education, and community-based outreach interventions are associated with improved screening uptake and reduced HBV-related morbidity and mortality.

Persistent HBV screening disparities reflect failures in implementation rather than gaps in evidence, underscoring the need for public health strategies that operationalize existing guidelines through culturally accessible and system-level interventions.